Suau Sans Maria, Manneh Muhammed, Ceesay Isatou, Bittaye Amat, de Crombrugghe Gabrielle, Keeley Alexander J, de Silva Thushan I, Palmer Jennifer, Armitage Edwin P, Marks Michael
Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
The Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
PLOS Glob Public Health. 2024 Mar 25;4(3):e0002257. doi: 10.1371/journal.pgph.0002257. eCollection 2024.
Group A Streptococcus (Strep A) bacteria causes a broad spectrum of diseases. The most common manifestations of Strep A infection are sore throat and pus-producing skin infections such as impetigo. Complications of Strep A infection can lead to inflammation in the bones, muscles, joints, and internal organs causing acute rheumatic fever and rheumatic heart disease (RHD). In The Gambia, the RHD burden is thought to be very high. However, epidemiological data is minimal, and Strep A control programmes do not exist. This study aimed to explore common beliefs and practices related to sore throats among primary caregivers of children, and healthcare providers in a community with a high Strep A disease burden. Four informal conversations with providers and fifteen semi-structured interviews with caregivers were conducted in the peri-urban area of Sukuta, The Gambia. Sampling was purposive and gradual, beginning from households identified to have recently experienced sore throat through a parallel cohort study. Themes explored in qualitative analysis included: sore throat causal attributions and diagnoses, care practises, health-seeking behaviour, and perceived barriers to using the biomedical sector. We found that sore throats were typically perceived to affect one child in a family, disproportionately or exclusively. Sore throats were rarely perceived as life-threatening, and awareness of links between sore throat and ARF or RHD was not reported among caregivers or providers in this study population. Most cases of sore throat were initially managed at home using traditional medicine which delayed resort to antibiotics, though in two instances of severe pain with the presence of exudate, fear that the child's life was at risk prompted care-seeking through the formal health system. Our findings can inform the development of tailored strategies to increase community knowledge of the potential long-term consequences of sore throats and appropriate care-seeking, alongside improvements in the health system, to prevent Strep A sequelae effectively.
A组链球菌（A群链球菌）可引发多种疾病。A群链球菌感染最常见的表现是喉咙痛和脓疱性皮肤感染，如脓疱病。A群链球菌感染的并发症可导致骨骼、肌肉、关节和内脏器官发炎，引发急性风湿热和风湿性心脏病（RHD）。在冈比亚，风湿性心脏病负担被认为非常高。然而，流行病学数据极少，且不存在A群链球菌控制项目。本研究旨在探讨A群链球菌疾病负担较高社区中儿童主要照料者和医疗服务提供者对喉咙痛的常见看法和做法。在冈比亚苏库塔的城郊地区，与医疗服务提供者进行了四次非正式交谈，并对照料者进行了15次半结构式访谈。抽样是有目的且逐步进行的，始于通过一项平行队列研究确定最近有喉咙痛经历的家庭。定性分析中探讨的主题包括：喉咙痛的病因归因和诊断、护理做法、求医行为以及使用生物医学部门的感知障碍。我们发现，喉咙痛通常被认为只影响一个家庭中的一个孩子，要么不成比例地影响，要么只影响一个孩子。喉咙痛很少被视为危及生命，在本研究人群的照料者或医疗服务提供者中，未报告对喉咙痛与急性风湿热或风湿性心脏病之间联系的认识。大多数喉咙痛病例最初在家中使用传统药物治疗，这延迟了抗生素的使用，不过在两例伴有渗出物的剧痛病例中，担心孩子生命受到威胁促使通过正规卫生系统寻求治疗。我们的研究结果可为制定针对性策略提供参考，以增加社区对喉咙痛潜在长期后果的认识和适当的求医行为，同时改善卫生系统，有效预防A群链球菌后遗症。
